AIBU to think that Cameron is telling nurses to do things that they already do?

[MyNameIsNotNurse]

Or aim to do given the oppertunity.
Link

David Cameron's 'ideas'
Hourly checks on patients to make sure they have had enought to eat/drink and are comefortable.
Isn't this just basic care?
Also to have members of the public doing spot checks on their local hospitals, isn't this just going a bit too far?

I would really like him to do a 12 hour shift on a busy ward, with sick people needing more than just the hourly walk around to make sure that things are ok.
What about the patients who are in need of 15 minute observations. Patients with poor mobility who take more than 30 seconds to get to the toilet and needs assistance every step of the way. What about the drug rounds? Then multiply that by 30 pateints for 2 staff nurses (some with little experiance) If 1 patient is really ill thats 1 nurse down so 30 patients beeing looked after by 1 nurse, and maybe 1 or 2 HCA.

Why does he not discuss the staffing issues, which most wards have the mountains of paper work which each and every nurse has to get through every shift which takes away from the care of patients.
Most nurses I know stay behind to finish paperwork, turn into work when they or their family is not well, go without breaks, work 12hours a shift, do extra shifts and Given up our measily 3% payrise over 3 years.

He's just making a lot of noise saying we should do things we already do in order that the public think we're not doing them and we lose support?

Agreed. And I have lost all patience with people who think that the reason patients are getting neglected in hospitals is because Nurses simply don't care.

I would like to take some of these people and give them 20 patients to handle all by themselves. 5 on insulin drips, 4 in acute CHF, 3 getting blood, 3 getting IGG, 2 on cardiac drips and throw in tube feeds, heparin drips, telemetry, cardiac drips oh yeah in 50% of them have dementia and are crawling over the bed rails and pulling out their lines.

In addition to that you are getting admissions (each admission takes an hour of focused work to ensure that you don't make a fatal mistake), people who are getting discharged are crawling up your ass, family members are crawling up your ass, the doctors are crawling up your ass, pharmacy is demanding paperwork in order to give you the drugs the doctor prescribed for your patients, social workers are calling every 5 minutes and demanding paper work. Same with every other department in the hospital. Risk management and legal are threatening you over paperwork that they need. Every time you start one task, you get interrupted. You have to cram every task into the 10 seconds you have between interruptions.

You have a 12 hour shift to deal with this all. That is less than one hour per patient. Each patient on one of those infusions will require you to be in and out of the room every 15 minutes to an hour to titrate.

I'd like to see one of these people who complaints about "uncaring nurses' try to handle all of this without killing someone and yet be patient, attentative, and cater to everyone's wants and whims at the same time. It's not doable, even if there was a gun to your head.

I once knew a nurse who got stopped to help a confused elderly lady. The time spent reassuring and assisting this lady caused her to miss a critical lab value that was faxed instead of called in. Patient died because the Nurse missed the lab (she was caring for patients rather than checking the computer and fax machine for abnormal results). Man on man did she get the book thrown at her. And the judge looked her right in the eyes and told her that if she was helping people to the bathroom rather than checking for abnormal lab values that might be phoned in at anytime then she "didn't know how to prioritize". They really fucking threw the book her her. Jail time and such.

The only help you are going to get is two untrained health care assistants who cannot help you with any of what I am describing above. And they expect you to help them with the only thing they can do...basic care. When you call the managers in the staffing office and ask for more help they are going to be rude and hang up on you. And they aren't the ones who get in trouble for lapses in care. The patients will see all the health care assistants hanging about and get mad wondering why "no one is helping them". A health care assistant can't help you with meds, infusions, catheters, discharge procedure, doctors orders, social work, etc etc etc all the other things that are going on. They can help you to the toilet if they are so inclined, and they will probably manage to even fuck that up, getting the Nurse into a heap of trouble.

Does anyone really think that it is possible to handle all this and remain sweet and angelic with unlimited time and patience for every patient you are responsible for? Oh and the patients have no idea what you have on your shoulders, their perception is their reality and all they know is that you didn't get into their room when they wanted you too. They have no concept of anything else. So they are going to be yelling at you all day. Run your ass off for 14 hours keeping everyone safe and doing the best you can and you get a 3 page letter of complaint about YOU because some asshole didn't like the tray kitchen sent up. It would never occur to these people to complain about kitchen!

Nurses are human not angels and they are going to respond to this high level of accountability with no control and tons of abuse in the same way any living creature would.

You can change Nurse training and fire all the "mean" nurses who didn't ignore priority procedures to give you "customer service" all you want. This won't fix a damn thing. If you want good care you need to staff your floors with RNs.

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Did anybody investigate why the lab value was faxed rather than phoned? And by whom?

Thought not.

It cuts all ways though. I remember a patient dying because an abnormal and potentially fatal result was given over the phone by the lab to the ward clerk. They didn't explain to her that she had to tell a qualified person immediately, or even ask to speak to a qualified person. She wrote it in the book, just like she always did, with routine results.

She was suspended and faced disciplinary procedures. Poor thing - she was a ward clerk - how was she supposed to know how to interpret results?

In that case the nurses weren't blamed, but it is the same culture of management blaming the wrong people.

I think that the lab should have been slammed for faxing rather than phoning but they weren't. The Nurse got it in the neck. I am surprised that they suspended that ward clerk! How the heck was she supposed to know what a K+ of 1.9 or an HgB of 6.0 means? My trust got rid of ward clerks anyway so the RNs always had to answer the phone and fill in the critical lab value form and then make the notification call to the doctor; and then fill in forms for any orders that he then gave to deal with the abnormal results. Obviously pharmacy won't give you stuff like addiphos and K riders unless you jump through 2 billion hoops first. And the transfusion department with their one million and one hoops to get a freaking a unit of blood. Holy shit.

Of course if you ask Mrs. H we should all just ignore that stuff and go to jail for manslaughter in order to be there the second a stable patient wants assistance with her pad. Sorry but I have young children, I don't want to end up the defendent in a murder trial and therefore I will decide what task I do and when.

On our local news tonight there was a report on the governments initiative regarding local pay agreements for public sector workers. It basically said that effectively nurses et all could potentially have their pay cut in the north compared to their equivalents in the south.

Now that is frightening

I was told that they are going to reduce the RNs pay down to band four which is on level with that of an HCA. One thing that I learned working in the UK is that unions are worthless. If managers and politicians do no want to pay for fair salaries and staffing, no one can make them. End of. My new hospital across the pond isn't perfect but we are NON unionized and the conditions are better.

Newjob I am the world"s biggest fan of the nursing profession but I too am delighted you're not nursing here.
Your comments about HCAs are shocking, as I have said previously it is the height of ignorance to make sweeping generalisations about an entire staff group.
Has there are some poor HCAs, as there are some poor nurses but, also like nurses I believe the majority are dedicated and hard working.

Even with the best, most hardworking, nicest HCAs on board the Nurse is still screwed.

HCAs were brought in as a money saving idea and not because anyone thought that they were a good idea. My two best friends are HCAs and they are visiting me in the states soon. They totally agree with me.

Most of the HCAs I worked with were good people who i got on with a liked a lot.

But I was still on my own with the RN only tasks, and that totally sucked.

I have no knowledge of the American health economy but in the UK, the increase in HCAs was as a direct result of Project 2000 and the withdrawal of student nurses as a part of the nursing workforce.
This was not a 'money saving idea'.

HCAs "They can help you to the toilet if they are so inclined, and they will probably manage to even fuck that up, getting the Nurse into a heap of trouble"
Some 'friend'

Bullshit Sauvignon. Nursing students still have to do 4000 hours on the wards to graduate.

When they graduate they will be thrown into a ward as the only qualified nurse, having to do all RN only tasks. They need to work with the RN and learn how to manage this, under supervision at all times. I do not want a new grad nurse caring for me if her nurse training was simply working on the wards as a care assistant.

HCAs were brought in because hospitals do not want to pay to staff their wards with RNs. Hospitals are always looking for the cheapest way to go. It is how they are trying to manage sky rocketing health care costs and an aging , chronically ill population. At my old NHS hospital they have now even deemed HCAs too expensive and are replacing them with less skilled and cheaper Cadets. These cadets are often teenagers with NO experience.

General ward patients are also a lot more complicated now. They are more than what a student nurse can handle on her own. Many patients who would have been on a ward years ago are treated as outpatients now. The patients we do have on the wards are chronic and complicated. These patients just did not survive in the past. Gone are the days where a student could run a ward in the absence of RNs. We have patients on the wards that would have been in ITU 10 years ago. There is no way that either a university or old fashioned student nurse could handle working independently on a modern floor.

And for liability reasons the student nurses are stopped from doing as much as they did in bygone decades. The lawyers today would have a field day if student Nurses were running wards. In the 1970's mistakes were more hidden and there were less lawsuits.

Instead of bringing HCAs in they should have hired and then retained their RN workforce at ward level.

and don't start with the "university ed for nurses is wrong rubbish" study after study has proven that hospitals with a higher proportion of degree educated RNs staffing their wards have lower mortality rates.

And highly educated nurses should be doing basic care as well as meds, assessments, troubleshooting and all the rest. In UK hospitals the nurses are so overwhelmed with their large patient loads that they cannot do basic care and have to delegate it to the HCAs. This means that the RN is working blind.

Basic care is part of the Nursing process, it is how patients are assessed for changes in condition. It's not enough to have someone who can do a good bed bath. You have to have someone knowledgable about doctors orders and the overall picture with the patient doing that basic care in order to prevent failure to rescue scenarios. A qualified nurse sees the whole picture.

If you want good care on your wards you need well educated RNs (preferably with a ratio of 1 nurse to 4 patients) doing all the care for those patients. "All the care" includes everything from bed bathing and toileting to titrating drips and liasing with doctors.

The whole team approach that they use in the UK where you have 1 nurse and a couple of unskilled unlicensed workers caring for a large group of patients is a total and utter fail. It doesn't work because the RN is stretched too thin. The HCAs do not catch on to changes in condition and potential problems when they are doing basic care as a nurse would.

It is erroneous and simplistic to think that because a bedbath is an easy skill that you should higher cheap workers to do it. Physically a bed bath is an easy skill but assessing a patient properly and comparing that with the whole picture while doing it is a different thing entirely.

I'm afraid you continue to show your ignorance of the background and history of nursing in the NHS. I do not think that your hyperbole is helping the debate.

When I started working on wards (10 years plus) staffing levels of all grades were high - often 3-4 registered nurses with 3-4 hca's. Now you're lucky to find 2 RN and 2 hca's. Whether this is a care driven or financial decision I don't know (i suspect the latter)

My mum was a sister and she always felt the profession declined with the end of the SRN and SEN roles where you had trained staff with a good skill mix on a ward. That shouldn't take away from the fact that there are some wonderful hca's out there working their bottoms of for relatively little pay.

Basic care is absolutely vital. I'll never forget admitting a man in his 80s and asking him if he'd had any surgery? No, none, dear. Next day, I'm helping him with his personal care, and say "That's a big scar, Ernie, where did you get that?" "Ohhh that's from my Cabbage in 1981" "Ohhh you've had quite big heart surgery then??" "Mmmm that's a big scar, too Ernie...what happened?" "Oh well that was my lobectomy in 1992" "Oh right...so they removed some lung?" "Yes dear".

"Ernie had actually had extensive operations, but had never had surgery

Once, I worked on a neurosurgery ward. I was newly qualified. In the morning I had 12 patients. 6 of whom were acutely unwell. In the afternoon, someone had phoned in sick, so I had 19 patients. The 6 acutely sick ones from the morning strangely hadn't got better by the afternoon , the other 6 from the morning needed just as much attention as they had done earlier in the day, and the 7 extra patients were in a bay at the other end of the ward.

So I had a situation where I had to keep a constant watch on 6 patients at one end of the ward, yet somehow care for the 6 patients with moderate needs (ie. one day post op, with drains, catheters, etc) and 7 patients with chronic conditions who needed full help with personal care at the other end of the ward.

As a nurse in theatres, if I was on call over night, I was the only qualified nurse in recovery. I got a care assistant to help me, but the law says that the qualified nurse is responsible for those under her. So, by having an extra member of staff, I was actually taking on the responsibility of her actions as well as mine.

Whatever Sauvignon,

I worked in the NHS 12 years ago and we had 5 experienced RNs on the ward for a shift. Now we are lucky to have 2 for the entire ward. Usually it was one (at least that is how it was in spring 2011 when I left).

HCAs have been hired instead of RNs. They haven't been hired in additon to RNs to make up for some imagined lack of students. They have been hired to replace RNs in order to help control costs. And now they are even doing away with the HCAs and replacing them with "cadets". These unlicensed workers are currently being used instead of RNs because they are cheaper. They are not being used in addition to Nurses, they are being used instead of Nurses. This has nothing to do with student nurses and everything to do with managers trying to cut costs.

The rot started in the United States in the 80's. They did the same damn thing. They decided to cut RNs in order to save money and replace them with unlicensed carers. And it was a big mistake. Now they are going back to having higher RN ratios in many US states. They have now realised that it is actually more cost effective to pay out to staff the wards with RNs.

The UK copied the idea of replacing Nurses with unlicensed carers from the the US. They thought it was a good money saving idea. That's why the problems your wards exist. It has nothing to do with Nurse training or Nurses suddenly becoming psychopaths or anything else.

There is a journalist called Suzanne Gordon who studies Nursing and writes about it. She isn't a Nurse but she has studied issues in Nursing extensively. She even spent years shadowing RNs on the wards fulltime. She has investigated hospitals and how they operate and control Nursing.

Check her out on amazon. Against the odds is worth a read. It documents a lot of what has happened in Nursing over the last 20 -30 years and it is also very relevant to the UK.